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        Use of the ultrasound-based total malignancy score in the management of thyroid nodules

        Giovanni Guido Pompili,Silvia Tresoldi,Anna Ravell,Alessandra Primolevo,Giovanni Di Leo,Gianpaolo Carrafiello 대한초음파의학회 2018 ULTRASONOGRAPHY Vol.37 No.4

        Purpose: The purpose of this study was to validate the role of the total malignancy score (TMS)in identifying thyroid nodules suspicious for malignancy through the sum of their ultrasoundfeatures. Methods: The local ethical committee approved this prospective observational study. Weexamined 231 nodules in 231 consecutive patients (164 females and 67 males; age range, 20 to87 years; median age, 59 years; interquartile range, 48 to 70 years) who underwent ultrasoundfollowed by fine-needle aspiration cytology (FNAC). The nodules were further classified usingthe TMS, which considers ultrasound features (number, echogenicity, structure, halo, margins,Doppler signal, calcifications, and growth), and the Bethesda System for Reporting ThyroidCytopathology (TBSRTC), which considers cytological features. Patients with non-negativenodules (TBSRTC categories III to VI) underwent histological analysis, repeated FNAC, or 2years of regular ultrasound follow-up. The associations between the final diagnosis, each of theultrasound features, and the TMS were estimated using the chi-square test, the Mann-WhitneyU test, and multivariate logistic regression. A receiver operating characteristic (ROC) curve wasused to evaluate the diagnostic accuracy of the TMS. Results: On ultrasound, 47% of the nodules (108 of 231) had a TMS <3, 18% (42 of 231) hada TMS of 3, and 35% (81 of 231) had a TMS >3. The FNAC results of 85% of the nodules (196of 231) were benign, while 15% (35 of 231) had non-negative results. Hypoechogenicity, solidstructure, the presence of microcalcifications, and the number of nodules were independentpredictors of the final diagnosis, and the diagnostic accuracy of the TMS was good (area underthe ROC curve, 0.82). Conclusion: The TMS system is simple to use, reliable, easily reproducible, and closely reflectsmalignancy risk. Based on our results, FNAC could be limited to nodules with a TMS ≥3 withoutmissing any cases of carcinoma.

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        A Population Health Surveillance Theory

        Farouk El Allaki,Michel Bigras-Poulin,Pascal Michel,André,Ravel 한국역학회 2012 Epidemiology and Health Vol.34 No.-

        OBJECTIVES: Despite its extensive use, the term ¨Surveillance¨ often takes on various meanings in the scientific literature pertinent to public health and animal health. A critical appraisal of this literature also reveals ambiguities relating to the scope and necessary structural components underpinning the surveillance process. The authors hypothesized that these inconsistencies translate to real or perceived deficiencies in the conceptual framework of population health surveillance. This paper presents a population health surveillance theory framed upon an explicit conceptual system relative to health surveillance performed in human and animal populations. METHODS: The population health surveillance theory reflects the authors’ system of thinking and was based on a creative process. RESULTS: Population health surveillance includes two broad components: one relating to the human organization(which includes expertise and the administrative program), and one relating to the system per se (which includes elements of design and method) and which can be viewed as a process. The population health surveillance process is made of five sequential interrelated steps: 1) a trigger or need, 2) problem formulation, 3) surveillance planning, 4) surveillance implementation, and 5) information communication and audit. CONCLUSIONS: The population health surveillance theory provides a systematic way of understanding, organizing and evaluating the population health surveillance process.

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